CT imaging of bone and bone marrow infiltration in malignant melanoma—Challenges and limitations for clinical staging in comparison to 18FDG-PET/CT

Bier, Georg; Hoffmann, V.; Kloth, Christopher; Othman, Ahmed E.; Eigentler, Thomas; Garbe, Claus; Fougère, Christian la; Pfannenberg, Christina; Nikolaou, Konstantin; Klumpp, Bernhard

doi:10.1016/j.ejrad.2016.01.012

Cited by 37 publications

(23 citation statements)

References 22 publications

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“…One of the significant challenges with FDG‐PET/CT is the false‐positive finding that can result from increased FDG uptake by inflammatory processes, which is an issue, because immunotherapy elicits a natural inflammatory response, and immune‐related adverse events also may demonstrate increased FDG uptake. Two studies in patients with melanoma demonstrated the inability of FDG‐PET/CT to differentiate between patients who had pseudoprogression because of inflammatory infiltrate and those who had actual PD . Cho et al evaluated the ability of FDG‐PET/CT in conjunction with other imaging modalities to predict early response to therapy in patients with advanced melanoma who receive treatment with several checkpoint inhibitors .…”

Section: Implementation Of Response Criteria In Clinical Trialsmentioning

confidence: 99%

“…Two studies in patients with melanoma demonstrated the inability of FDG-PET/CT to differentiate between patients who had pseudoprogression because of inflammatory infiltrate and those who had actual PD. 15,16 Cho et al evaluated the ability of FDG-PET/CT in conjunction with other imaging modalities to predict early response to therapy in patients with advanced melanoma who receive treatment with several checkpoint inhibitors. 17 At each post-treatment time point, response was assessed based on RECIST 1.1, irRC, Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST 1.0), and European Organization for Research and Treatment of Cancer criteria.…”

Section: Immunotherapy and The Role Of Imaging/carter Et Almentioning

confidence: 99%

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Immunotherapy and the role of imaging

Carter

Bhosale

Yang

2018

Cancer

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Significant advances in the genetic and molecular characterization of cancer have led to the development of effective immunotherapies. These therapeutics help the host immune system recognize cancer as foreign, promote the immune system, and relieve the inhibition that allows growth and spread of tumors. Experience with various immunotherapies, particularly the immunomodulatory monoclonal antibody ipilimumab, has demonstrated that unique patterns of response may be encountered that cannot be adequately captured by traditional response criteria, such as the World Health Organization (WHO) criteria and Response Evaluation Criteria in Solid Tumors (RECIST), which have been used primarily with cytotoxic chemotherapies. In response to these observations, several novel response criteria have been developed to evaluate patients who receive immunotherapy, including immune-related response criteria (irRC), immune-related RECIST (irRECIST), and immune RECIST (iRECIST). These criteria are typically used in conjunction with RECIST version 1.1 in the clinical trial setting, because approval of new therapeutics by the US Food and Drug Administration relies on the responses derived from RECIST version 1.1. Finally, a wide variety of immune-related adverse events may affect patients who receive immunotherapy, many of which can be identified on imaging studies such as computed tomography, magnetic resonance imaging, and 2-deoxy-2-(fluorine-18)fluoro-D-glucose-positron emission tomography/computed tomography. In this review, the authors present the role of imaging in the evaluation of patients treated with immunotherapy, including the background and application of irRC, irRECIST, and iRECIST; the imaging of immune-related adverse events; and future directions in advanced imaging of immunotherapy. Cancer 2018;124:2906-22. © 2018 American Cancer Society.

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Section: Implementation Of Response Criteria In Clinical Trialsmentioning

confidence: 99%

Section: Immunotherapy and The Role Of Imaging/carter Et Almentioning

confidence: 99%

Immunotherapy and the role of imaging

Carter

Bhosale

Yang

2018

Cancer

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“…Only very limited data are available for the evaluation of immunotherapy by means of 18 F-FDG-PET. Two clinical experiences have been made in 49 patients [6, 7], demonstrating the inability of 18 F-FDG PET/CT make a differential diagnosis between patients with pseudo-progression (due to inflammatory infiltrate) from those with a real progression, during immunotherapy. In fact, it has been reported that the initial increase in tumor size, later followed by tumor volume reduction in part of the patients treated with immune checkpoint inhibitors, is due to inflammatory cell infiltrates [2, 6, 7].…”

Section: How To Evaluate the Response To Immunotherapy?mentioning

confidence: 99%

The new era of cancer immunotherapy: what can molecular imaging do to help?

Evangelista

Jong

Vecchio

et al. 2017

Clin Transl Imaging

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“…A few studies have reported that 18 F-FDG-PET/CT can potentially predict early response to PD-1 blockade or CTLA-4 blockade in patients with non-small cell lung cancer or melanoma 18,19 . However, several studies have also demonstrated the inability of 18 F-FDG-PET/CT to distinguish patients with pseudoprogression from those with progressive disease in melanoma patients 20,21 . Thus, to date, non-invasive imaging approaches to clarify the early response to effective immunotherapy in vivo have not been established.…”

Section: Introductionmentioning

confidence: 99%

Detecting Early Response to Immune Checkpoint Blockade by Multimodal Molecular Imaging

Saida

Brender

Yamamoto

et al. 2020

Preprint

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Immune checkpoint inhibitors have become a standard therapy for several cancers; however, the response is inconsistent and a method for non-invasive assessment has not been established to date. To investigate the capability of multi-modal imaging to evaluate treatment response to immune checkpoint blockade therapy, we employed hyperpolarized 13 C MRI on tumor bearing mice using [1-13 C] pyruvate and [1,4-13 C2] fumarate to detect early changes in tumor glycolysis and necrosis, respectively. Following αPD-L1 Ab + αCTLA-4 Ab dual immune checkpoint blockade (ICB) therapy, dynamic contrast enhanced (DCE) MRI was used to determine the treatment effect on intratumor perfusion/permeability. Mice bearing MC38 colon adenocarcinoma and B16.F10 melanoma were used as sensitive and less sensitive models, respectively to immune checkpoint dual blockade of PD-L1 and CTLA-4. Glycolytic flux significantly decreased upon treatment in the less ICB sensitive B16.F10 model but remained essentially unchanged in MC38 tumors. Imaging [1,4-13 C] fumarate conversion to [1,[4][5][6][7][8][9][10][11][12][13] C] malate showed a significant increase in necrosis in the treatment group for the ICB sensitive MC38 tumor (p = 0.0003), with essentially no change in ICB sensitive B16.F10 tumors. Histological assessment showed increased necrotic tissue with enhanced lymphocyte infiltration in the MC38 treatment group, suggesting immunogenic tumor cell death. Dynamic contrast enhanced MRI showed significantly increased perfusion/permeability of Gd-DTPA in MC38 treated tumor, while a similar trend but statistically non-significant change was observed in B16.F10 treated tumor. These results provide imaging biomarkers to detect early response to cancer immunotherapy, allowing qualitative assessment of tumors treated with immune checkpoint blockade therapy.

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CT imaging of bone and bone marrow infiltration in malignant melanoma—Challenges and limitations for clinical staging in comparison to 18FDG-PET/CT

Cited by 37 publications

References 22 publications

Immunotherapy and the role of imaging

Immunotherapy and the role of imaging

The new era of cancer immunotherapy: what can molecular imaging do to help?

Detecting Early Response to Immune Checkpoint Blockade by Multimodal Molecular Imaging

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